- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $47.23 / $61.32 / $1,168.97
| Facility | 26 | $47.23 | $61.32 | $1,168.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.31 / $220.81 / $271.88
| Professional | | $126.31 | $220.81 | $271.88 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $44.14 / $51.30 / $206.19
| Professional | 26 | $44.14 | $51.30 | $206.19 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $80.86 / $148.06 / $201.03
| Professional | TC | $80.86 | $148.06 | $201.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $133.66 / $248.05 / $360.45
| Professional | | $133.66 | $248.05 | $360.45 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $35.21 / $58.14 / $86.29
| Professional | 26 | $35.21 | $58.14 | $86.29 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $85.91 / $171.78 / $295.50
| Professional | TC | $85.91 | $171.78 | $295.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $132.63 / $239.10 / $239.10
| Professional | | $132.63 | $239.10 | $239.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $46.05 / $59.05 / $518.57
| Professional | 26 | $46.05 | $59.05 | $518.57 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $85.51 / $85.51 / $85.51
| Professional | TC | $85.51 | $85.51 | $85.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.68 / $215.54 / $353.87
| Professional | | $128.68 | $215.54 | $353.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $39.53 / $64.84 / $112.02
| Professional | 26 | $39.53 | $64.84 | $112.02 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $87.25 / $146.13 / $281.44
| Professional | TC | $87.25 | $146.13 | $281.44 |